Hope in Despair

Two children died coming into this world before, and now the next was at stake. The 20 year old couple had lost too many for so few years. In fact, they only had losses, no living children. They were offered a C-section, as the child was breech, but declined. Labor ensued. Hope mixed with pain, the intensity of which worsened after the water broke and trickled onto the floor. The young man was obviously concerned as he watched his wife. Awkward and young, he didn’t know what to do or say, but he kept coming to check on her. She called to him as she began to push, and obediently, he came. The nurse told him that he could rub her back to help with the pain. Massage isn’t really practiced here, but he tried to do what he imagined she was telling him to. The child came, a bit closer, and closer. But the pushing continued. Joy came closer with each millimeter of progress. No electronic monitors available, so the nurse listened every few minutes.

Oh I love that sound of the fetal heartbeat. That rhythm brings a slight nod of my head and pulse of my fingers that ensures me that everything is okay. I miss the continuous rhythm of electronic monitoring, the transmitted beats written on the page, and delighting my ears. Fetal monitoring in the developed world comforts me, but here, there is no fetal monitor. Only an occasional, momentary check to make sure the heartbeat is still there. No soothing, continuous “da-dum, da-dum” to nod my head with.

And then the nurse went to check again, and it was gone. She could hear nothing but the swish of the maternal pulse. Had the child shifted, or was it there, but hard to hear? I imagined hearing some faint sound, but I could tell it was only an imagination of my mind. I called ultrasound to come. But with no ultrasound immediately available on maternity, there was nothing to do but wait for them to bring the machine. The worst thing would be to do emergent surgery on an already deceased baby. That would bring higher risk to mother, but no reward in a child. So we waited, and anxiously searched for the heartbeat with the fetoscope until the ultrasound finally came. It confirmed there was no heartbeat.

Our hearts sunk, as now there was only one course of action. She couldn’t push anymore, and the fit was tight through those young bones. Terrible, terrible delivery it was. Intentional, forceful removal of the fragile infant’s body is one hardest things for an obstetrician to feel beneath our hands. It brings me a wave of nausea to have to deliver intentional harm like that. We, who love to bring life, also have the job when outcomes are at their worst. And this was certainly worst. All of the prior impending joy was lost as we struggled to complete this delivery.

A hundred backward glances over the days to follow. Wishing for more resources outside, more wisdom inside. Every morning I rounded on the woman. My uncomfortable eyes meeting with hers, another reminder to me of the failures that can occur with our best skill and intention. I knew it was not truly my fault, but there was a constant twinge of guilt. I fought against the thoughts that came –“I am the one who is supposed to be able to help”, “I’m supposed to give them a live baby when the past ones all died in the village”, “They’ve come to the hospital because I am a specialist here”. I could think of nothing else I could have done or offered though. The course was reasonable right up until the difficult delivery. If I knew the future, knew the outcome, we could have changed the course. But only God can know these things. I pray for wisdom to choose smooth paths, compassion to walk patients through rough ones.

In spite of circumstance, the young woman and her husband were continually gracious and appreciative. Was it their humble state in life, filled with poverty and loss, that left them numb?  Had it not sunk in? Was this culturally appropriate external action, while brokenness or anger lay concealed inside?

My greatest hope was that it was something more. I hoped that God had given peace, surpassing circumstance. He speaks of it as a “peace that passes understanding”. It is what lets the soul rest in Him, while storms rage all around. It is not ignorance, or numbness, or a false mask of joy. It knows great pain, acknowledges brokenness, it feels disappointment – but it knows the gentle and comforting hands of the Father hold them in the midst of it all. We come to know this peace most often when we find ourselves beyond our limits, during times when life gives us more than we can bear. It is then that self-sufficiency is lost, and we recognize our need for God’s sufficiency. And thankfully, when we realize our need, He comes to fill it. We have mountaintop experiences with God dotted throughout life, but these experiences in the darkness and hopelessness of the depths are where we come to know and trust Him most. I hope and pray that this young couple has found Him as a comforting guide to walk them through these hard times.